Method And Apparatus For Optimizing A Computer Assisted Surgical Procedure

ABSTRACT

A method and apparatus for optimizing a computer assisted procedure is provided. A method and apparatus for performing a procedure is also provided. Data can be accessed and processed to optimize and perform a procedure. The data can be augmented or supplemented with patient specific data.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No. 11/683,796 filed on Mar. 8, 2007, which claims the benefit of U.S. Provisional Application No. 60/848,442, filed on Sep. 29, 2006. The disclosures of the above applications are incorporated herein by reference.

FIELD

The present disclosure relates to a method and apparatus for performing a computer assisted surgical procedure, and particularly to a method and apparatus for optimizing a computer assisted surgical procedure.

BACKGROUND

The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.

Various procedures can be performed on the anatomy of a patient to assist in providing various treatments to the patient. For example, an orthopedic procedure can include implanting a prosthesis or repairing an anatomical structure of a patient. Additional surgical procedures can include neurological procedures, cardiovascular procedures, and the like. Some of these exemplary procedures are generally selected to be performed in a small or minimally invasive manner. Some surgical procedures are performed in very surgically sensitive areas of the patient, such as in the brain or spinal area. In various procedures, therefore, an assistive system, such as an imaging or navigation system can be used to assist in a procedure. For example, a navigation system can be used to assist in illustrating a position of a device or instrument relative to a patient.

Although imaging systems to image portions of the anatomy and navigation systems are generally available, they may not provide multiple levels or types of information to the user. For example, an imaging device may generally only be able to provide one or two types of image data for use by a user. Nevertheless, providing several types of data for use during a single procedure may be desirable. For example, it may be desirable to provide a generally accepted map of a selected portion of the anatomy, such as the brain, for review during a procedure. It may also be desirable to illustrate a map of the anatomy relative to a patient specific image to assist in determining or verifying a location or target in the anatomy.

In addition, it may be desirable to provide a system that allows for integration of numerous types of systems. For example, it may be desirable to provide a system that allows for integration of both a navigation system, an imaging system, a data feedback system, and the like. Therefore, it is desirable to provide a system that allows for integration of several systems to allow for a synergistic approach to performing a selected surgical procedure. It is also desirable to provide an adaptive system that allows updating of static or database models to optimize various surgical procedures.

SUMMARY

Taught herein is a method and apparatus for providing an integrated adaptive system and approach to performing a surgical procedure. This system may be provided to obtain or display a selected type of data relating to a portion of the anatomy, and the system may allow for the synergy of several types of information for a single user. For example, image data of a particular patient, atlas information, instrument or recorder information, navigation information, archived or historical information, patient specific information and other appropriate types of information. All can be provided on or by a single system for use by a user during an operative procedure, after an operative procedure, or prior to an operative procedure.

In one example, various types of data can be provided to a user to plan a selected procedure. The plan and various types of data can be provided to a user during the actual procedure to assist navigating and assuring that the procedure is performed according to the plan. The data can also allow a user to perform a follow-up or programming of a device for a particular procedure. The data can assist the user in ensuring that an appropriate therapy is provided to a selected area of the anatomy, such as the brain. In addition, the various types of data can be used to post-operatively assist in refining various databases of data, such as atlases, including the anatomical and functional locations defined therein.

Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way.

FIG. 1 is a schematic block diagram of an optimization system according to various embodiments;

FIG. 2 is an environmental view of a navigation system according to various embodiments;

FIG. 2A is an environmental view of a navigation system according to various embodiments;

FIG. 2B is an environmental view of a navigation system according to various embodiments;

FIG. 3 is an illustration of three-dimensional atlas data according to various embodiments;

FIG. 4 is an illustration of image data and atlas data according to various embodiments;

FIG. 5 is an illustration of image data and planning data according to various embodiments;

FIG. 6 is an illustration of various types of data including image data, physiological data, icon data, atlas data, according to various embodiments;

FIG. 7 is an illustration of tracking and positioning of a device relative to an anatomy;

FIG. 8 is a perspective view of a work station including a display displaying various types of data according to various types of embodiments;

FIG. 9A is an illustration of an affect of a therapy according to various embodiments;

FIG. 9B is a display of image data including an icon representing an affected area according to a selected therapy according to various embodiments;

FIG. 10A is image data including an icon representing a selected therapy's affect on the anatomy;

FIG. 10B is an illustration of image data with an icon representing an area of the anatomy affected by a selected therapy;

FIG. 11 is a block diagram graphical representation of an optimization system; and

FIG. 12 is an illustration of physiological data according to various embodiments.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses.

With reference to FIG. 1, an optimization or synergistic system 1 is illustrated. The optimization system 1 can allow the provision of numerous types of data to be used or provided for planning a procedure, performing a procedure, optimizing a procedure, or assisting in updating or enhancing the data 2. The data 2 can include various types of data. Exemplary data can include atlas data 2 a, patient image data 2 b, acquired physiological data 2 c, patient specific data 2 d, and archived or statistical functional data 2 e.

The various types of data 2 can be provided within the optimization system of 1 for use in various portions of the optimization procedure 1 The optimization system 1 can include a procedure planning 3, performing a procedure 4, or optimizing and programming a system 5, such as an implantable device. The various types of data 2 can be provided in any appropriate manner, such as visually, a list, a database, a computer accessible database, or the like.

The various types of data 2, although only exemplary and not intended to be an exhaustive list, can include atlas data 2 a. The atlas data 2 a can be any appropriate atlas data, such as a neurological atlas data, a cardiovascular atlas data, a musculature atlas data, skeletal atlas data, or the like. The atlas data can include three-dimensional atlas data 100 (FIG. 3) of selected portions of the anatomy. For example, atlas data can include three-dimensional atlas data of a neurological feature or structure, such as the sub-thalamic nucleus, various ventricles, and the like. Atlas data can also include two-dimensional atlas data 102 (FIG. 4) of portions of the anatomy, such as neurological portions. Other atlas data can also include the various boundaries of anatomical or functional features, locations of various anatomical or functional features, or any appropriate atlas data. Generally, the atlas data can be understood to be a well defined image data of a single or multiple patients. Generally accepted locations of functional or anatomical locations in an anatomy can be provided in the atlas data. The atlas data, as discussed further herein, can then be used to determine various functional or anatomical locations within an image data of a particular patient.

The data 2 provided within the optimization system 1 can also include the patient specific image data 2 b. The patient specific image data 2 b can be acquired in any appropriate manner, including those discussed further herein. The acquired image data can include magnetic resonance imaging data, diffusion tensor image data, optical coherence tomography image data, x-ray image data, or any appropriate image data. The patient image data can be acquired at any appropriate time, such as pre-operatively, intra-operatively or post-operatively. Also, as discussed further herein, the patient image data 2 b can be registered to the atlas data 2 a for use by a user within the optimization system 1. The atlas data 2 a can be fitted to the image data of the patient 2 b in any appropriate manner, also discussed further herein.

Also, other types of exemplary patient data that can be acquired, can include physiological data 2 c. The physiological data 2 c can be any appropriate type of data, such as electrical signal data recorded with a micro-electrode recorder (MER). Micro-electrode recording is understood by one skilled in the art and can be used to precisely pin point or locate various portions of the anatomy. For example, the MER can be used to determine the electrical signal relative to a single neuron or to a group of neurons. Further, the MER can be moved through the neurological tissue to determine differences between selected regions of a patient. The acquired physiological data, however, can also include any appropriate type of data, such as optical coherence tomography data 220 (see FIG. 12), temperature data, hydraulic data, or the like. The acquired physiological data can also be used with or superimposed on various types of patient specific data, such as the patient image data 2 b. The acquired physiological data 2 c can also be used to assist in an appropriate registration, re-registration or superimposing of the atlas data 2 a onto the patient image data 2 b.

In addition, various patient specific data in block 2 d can also be provided. The patient specific data 2 d can also include data, such as prior procedures, physical issues with the particular patient 14, or any appropriate patient specific data. The patient specific data 2 d can also include a particular geometry or the patient, known locations of portions of the anatomy of the patient, and the like. Patient specific data 2 d can also include functional data of the patient. Also, patient specific data can include function data acquired during a particular procedure. Functional data can include microelectrode recording data, pressure data, gating data, etc. Functional data, according to various embodiments, can be obtained with a microelectrode recorder, a scope, a catheter, or any other appropriate instrument.

In addition, as discussed above, the data 2 can include various archived or multiple procedural data portions or data sets 2 e. Although various portions of the data can be integrated into the atlas data 2 a, an additional database of data can include the archived or statistical functional data 2 e. The archived and statistical functional data 2 e can include data obtained during the performance of the procedure in block 4 or during the optimization and programming of the device, which can be implanted in the patient 14 in block 5. Archived or statistical functional data 2 e can also include functional data of a group or previous patients. Functional data can include microelectrode recording data, pressure data, gating data, etc. The archived functional data can be used to augment data base data, including an atlas or other appropriate data. Therefore, the data in block 2 can include both data relating to the particular patient and to historical data that can assist in optimizing static data, such as atlas data, to a particular patient.

It will be understood that the system 1, as illustrated in FIG. 11, can include a substantially graphical interface that allows for both representation of the static and archived data and for manipulation of the data. Further, the archived data can be provided in a graphical manner relative to the patient specific data for illustration and reference during a particular procedure.

The data 2 can be provided to any appropriate procedure planning system 3. As discussed further herein, the data 2 can also be provided to an optimization or programming system for a device 5. The data 2 can be used in the procedure planning 3 or in the optimization programming system 5 to enhance or optimize a procedure on a particular patient. For example, the procedure planning block 3 can use the data 2 to assist in pre-selecting a target for a therapy, selecting a trajectory to reach the target for therapy, determining an appropriate amount of therapy, determining an appropriate type of therapy, or other appropriate pre-surgical planning information.

The data 2 can be provided, generally, in a database for access by a system or user. As discussed further herein, a workstation including a processor or any appropriate processor can execute instructions relating to the data base of the data 2. The database of the data 2 can be stored on a memory system for access by the processor. Thus, the data 2 can be accessed for use during a procedure, as discussed herein.

Also, as discussed further herein, a feedback 6 can allow the database of the data 2 to be augmented or updated. The database data 2 can be augmented or updated for use in multiple procedures or only in a current procedure. In this way, the data 2 in the database can be used in one or multiple procedures and accessed by multiple users. Thus, the data 2 can be used to optimize or assist in several procedures and updated and improved over time.

The data 2 in the database, can be accessed for use in a procedure. The data 2 in the database can be stored on a local memory system or accessed via a communications network. This can allow a centralized storage and access of the data 2 to efficiently update and augment the data 2 with numerous procedure data.

In planning a procedure, the patient image data 2 b can be further refined with the acquired physiological data 2 c or other patient specific information 2 d. This can assist determining the location of the various anatomical or functional locations. Further, the data 2 can also include specific inputs or database inputs of the effective therapies on selected portions of the anatomy. For example, known effects of electrical stimulation, material delivery, or the like can be provided to assist in planning a procedure, including the amounts or type of therapy to be provided to a selected target or region.

Also, as discussed herein and illustrated in FIGS. 8-10B, various types of data can be used to illustrate the affect on the anatomy during a programming in the optimization of programming in block 5. However, this data can also be used pre-operatively, when illustrated relative to a selected location, such as a target location, to illustrate a possible affect of a therapy to be provided at the selected location. Therefore, the image data, atlas data, and the other database data can be used to plan a procedure. For example, an icon representing the implanted probe can be positioned on the image data of the patient and an icon representing an area affected by the therapy can be displayed relative to the probe. Planning the procedure can be used to select an optimal location, an optimal therapy based upon the optimal location, an optimal trajectory to attempt to reach the application, and the like. The instrument that is implanted can include a plurality of instruments, such as a plurality of DBS leads. Each of the instruments can be activated or used separately or together to provide a therapy.

The procedure planned in block 3 can also be performed in block 4 with the assistance of the data 2. As discussed herein, a device or instrument can be navigated relative to a patient, based upon the planned procedure from block 3, which is based upon the data from block 2. The navigation can be substantially imageless or with images to assist in ensuring that an appropriate location of the instrument or device is reached. Further, the data can be used to illustrate the type of therapy being provided and the effect of the therapy being provided to the patient. Also, various imaging techniques can be used to intraoperatively verify positioning of a selected device to ensure that the plan from the procedure planning of block 3 has been achieved.

As understood by one skilled in the art, various types of devices may be programmed or optimized once they are implanted or positioned relative to a patient. For example, a deep brain stimulator (DBS) probe can be implanted into the brain and can be programmed over time to achieve an optimal result. It will be understood, however, that various types of implantable devices can also be employed to provide any appropriate type of therapy, such as a pacing lead, a drug delivery therapy, a pharmaceutical delivery, a cell or gene delivery therapy, or any appropriate type of therapy and delivery. Therefore, the optimization and programming system in block 5 can use the data from block 2 to assist in determining the appropriate type of programming that should be provided. For example, also discussed further herein, an appropriate voltage and pulse width can be programmed for an appropriate lead to stimulate a selected portion of the anatomy. The data from block 2 can be used to assist in determining the appropriate voltage, the appropriate pulse width, and the appropriate lead to be activated.

Also, the optimization and programming system for the device 5 can be used to assist in creating or augmenting the data in block 2, via feedback 6. For example, when providing a selected voltage, pulse width, and the like achieves the selected result or achieves a particular result, the data from block 2 can be augmented or changed based upon the observed result. The optimal location or optimal initial voltage, pulse width, therapy delivery, or the like can be input for retrieval when planning a procedure 3 from the data block 2.

The procedure can be planned or performed with any appropriate system, which can include a navigation system 10 (FIG. 2). The navigation system 10 can be used by any appropriate individual, such as a user to assist in both planning and performing a procedure. Nevertheless, the data 2 can be used and processed by a user or an electronic processor to assist in planning or performing a procedure.

With reference to FIG. 2 the navigation system 10 that can be used for various procedures in relation to the optimized therapy plan and system 1. The navigation system 10 can be used to track the location of a device, such as a delivery device, relative to a patient 14 to assist in the implementation of the plan in block 3, and discussed herein. It should be further noted that the navigation system 10 may be used to navigate or track other devices including: catheters, probes, needles, leads, implants, etc. Moreover, the navigated device may be used in any region of the body. The navigation system 10 and the various devices may be used in any appropriate procedure, such as one that is generally minimally invasive, arthroscopic, percutaneous, stereotactic, or an open procedure. Although an exemplary navigation system 10 including an imaging system 12 are discussed herein, one skilled in the art will understand that the disclosure is merely for clarity of the present discussion and any appropriate imaging system, navigation system, patient specific data, and non-patient specific data can be used. For example, the imaging system can include an MRI imaging system 12′ (FIG. 2A) or an O-arm imaging system 12″ (FIG. 2B).

The navigation system 10 can include the optional imaging device 12 that is used to acquire pre-, intra-, or post-operative or real-time image data of a patient 14. The image data acquired with the imaging device 12 can be used as part of the patient specific information in block 2. Alternatively various imageless systems can be used or images from atlas models can be used to produce patient images, such as those disclosed in U.S. patent application Ser. No. 10/687,539, filed Oct. 16, 2003, entitled “METHOD AND APPARATUS FOR SURGICAL NAVIGATION OF A MULTIPLE PIECE CONSTRUCT FOR IMPLANTATION”, incorporated herein by reference. The optional imaging device 12 is, for example, a fluoroscopic X-ray imaging device that may be configured as a C-arm 16 having an X-ray source 18, an X-ray receiving section 20, an optional calibration and tracking target 22 and optional radiation sensors 24. The calibration and tracking target 22 includes calibration markers (not illustrated). Image data may also be acquired using other imaging devices, such as those discussed above and herein.

An optional imaging device controller 28 may control the imaging device 12, such as the C-arm 16, which can capture the x-ray images received at the receiving section 20 and store the images for later use. The controller 28 may also be separate from the C-arm 16 and can be part of or incorporated into a work station 31. The controller 28 can control the rotation of the C-arm 16. For example, the C-arm 16 can move in the direction of arrow 30 or rotate about a longitudinal axis 14 a of the patient 14, allowing anterior or lateral views of the patient 14 to be imaged. Each of these movements involves rotation about a mechanical axis 32 of the C-arm 16. The movements of the imaging device 12, such as the C-arm 16 can be tracked with a tracking device 59.

In the example of FIG. 2, the longitudinal axis 14 a of the patient 14 is substantially in line with the mechanical axis 32 of the C-arm 16. This enables the C-arm 16 to be rotated relative to the patient 14, allowing images of the patient 14 to be taken from multiple directions or about multiple planes. An example of a fluoroscopic C-arm x-ray device that may be used as the optional imaging device 12 is the “Series 9600 Mobile Digital Imaging System,” from GE Healthcare, (formerly OEC Medical Systems, Inc.) of Salt Lake City, Utah. Other exemplary fluoroscopes include bi-plane fluoroscopic systems, ceiling fluoroscopic systems, cath-lab fluoroscopic systems, fixed C-arm fluoroscopic systems, isocentric C-arm fluoroscopic systems, 3D fluoroscopic systems, intraoperative O-arms, etc.

In operation, the C-arm 16 generates X-rays from the −X-ray source 18 that propagate through the patient 14 and calibration and/or tracking target 22, into the X-ray receiving section 20. This allows direct visualization of the patient 14 and radio-opaque instruments in the cone of X-rays. It will be understood that the tracking target or device need not include a calibration portion. The receiving section 20 generates image data representing the intensities of the received X-rays. Typically, the receiving section 20 includes an image intensifier that first converts the X-rays to visible light and a charge coupled device (CCD) video camera that converts the visible light into digital image data. Receiving section 20 may also be a digital device that converts X-rays directly to digital image data for forming images, thus potentially avoiding distortion introduced by first converting to visible light. With this type of digital C-arm, which is generally a flat panel device, the optional calibration and/or tracking target 22 and the calibration process discussed below may be eliminated. Also, the calibration process may be eliminated or not used at all for various procedures. Alternatively, the imaging device 12 may only take a single image with the calibration and tracking target 22 in place. Thereafter, the calibration and tracking target 22 may be removed from the line-of-sight of the imaging device 12.

Two dimensional fluoroscopic images that may be taken by the imaging device 12 are captured and stored in the C-arm controller 28. Multiple two-dimensional images taken by the imaging device 12 may also be captured and assembled to provide a larger view or image of a whole region of a patient, as opposed to being directed to only a portion of a region of the patient. For example, multiple image data of a patient's leg or cranium and brain may be appended together to provide a full view or complete set of image data of the leg or brain that can be later used to follow contrast agent, such as Bolus or therapy tracking.

The image data can then be forwarded from the C-arm controller 28 to a navigation computer and/or processor controller or work station 31 having a display 34 to display image data 36 and a user interface 38. The work station 31 can also include or be connected to an image processor, navigation processor, and memory to hold instruction and data. The work station 31 can include an optimization processor, which includes the system 1, as discussed herein, or a separate optimization processor system 39 can be included. The optimization processor system 39 can also include a display 39 a and a user input 39 b. It will also be understood that the image data is not necessarily first retained in the controller 28, but may also be directly transmitted to the workstation 31, which can also include an image processor, navigation processor, memory, etc. Moreover, processing for the navigation system and optimization can all be done with a single or multiple processors.

The work station 31 or optimization processor 39 provides facilities for displaying the image data 36 as an image on the display 34, saving, digitally manipulating, or printing a hard copy image of the received image data. The user interface 38, which may be a keyboard, mouse, touch pen, touch screen or other suitable device, allows a physician or user 67 to provide inputs to control the imaging device 12, via the C-arm controller 28, or adjust the display settings of the display 34. The work station 31 may also direct the C-arm controller 28 to adjust the rotational axis 32 of the C-arm 16 to obtain various two-dimensional images along different planes in order to generate representative two-dimensional and three-dimensional images.

The optimization processor 39 can be provided in any appropriate format, such as a substantially portable format. The optimization processor 39 can be used in any appropriate portion of the optimization process or system 1. For example, the optimization processor 39 can be separate from the navigation processor to allow for planning of the procedure, programming of the device in step 5, or any appropriate portion.

Various calibration techniques can be used to calibrate the imaging device 12. Intrinsic calibration, which is the process of correcting image distortion in a received image and establishing the projective transformation for that image, involves placing the calibration markers in the path of the x-ray, where the calibration markers are opaque or semi-opaque to the x-rays. A more detailed explanation of exemplary methods for performing intrinsic calibration are described in the references: B. Schuele, et al., “Correction of Image Intensifier Distortion for Three-Dimensional Reconstruction,” presented at SPIE Medical Imaging, San Diego, Calif., 1995; G. Champleboux, et al., “Accurate Calibration of Cameras and Range Imaging Sensors: the NPBS Method,” Proceedings of the IEEE International Conference on Robotics and Automation, Nice, France, May, 1992; and U.S. Pat. No. 6,118,845, entitled “System And Methods For The Reduction And Elimination Of Image Artifacts In The Calibration Of X-Ray Imagers,” issued Sep. 12, 2000, the contents of which are each hereby incorporated by reference.

While the optional imaging device 12 is shown in FIG. 2, any other alternative 2D, 3D or 4D imaging modality may also be used. For example, any 2D, 3D or 4D imaging device, such as isocentric fluoroscopy, bi-plane fluoroscopy, ultrasound, computed tomography (CT), multi-slice computed tomography (MSCT), magnetic resonance imaging (MRI), high frequency ultrasound (HIFU), positron emission tomography (PET), optical coherence tomography (OCT) (a more detailed discussion on optical coherence tomography (OCT), is set forth in U.S. Pat. No. 5,740,808, issued Apr. 21, 1998, entitled “Systems And Methods For Guiding Diagnostic Or Therapeutic Devices In Interior Tissue Regions” which is hereby incorporated by reference), intra-vascular ultrasound (IVUS), intra-operative CT, single photo emission computed tomography (SPECT), planar gamma scintigraphy (PGS). Addition imaging systems include intraoperative MRI systems 12. (FIG. 2A), such as the PoleStar® MRI system sold by Medtronic, Inc. Further systems include the O-Arm™ imaging system 12 (FIG. 2B) sold by Breakaway Imaging, LLC. The images may also be obtained and displayed in two, three or four dimensions. In more advanced forms, four-dimensional surface rendering regions of the body may also be achieved by incorporating patient data or other data from an atlas or anatomical model map or from pre-operative image data captured by MRI, CT, or echocardiography modalities.

Image datasets from hybrid modalities, such as positron emission tomography (PET) combined with CT, or single photon emission computer tomography (SPECT) combined with CT, could also provide functional image data superimposed onto anatomical data to be used to confidently reach target sights within the patient 14. It should further be noted that the optional imaging device 12, as shown in FIG. 2, provides a virtual bi-plane image using a single-head C-arm fluoroscope as the optional imaging device 12 by simply rotating the C-arm 16 about at least two planes, which could be orthogonal planes to generate two-dimensional images that can be converted to three-dimensional volumetric images. By acquiring images in more than one plane, an icon representing the location of an impacter, stylet, reamer driver, taps, drill, or other instrument, or probe introduced and advanced in the patient 14, may be superimposed in more than one view on display 34 allowing simulated bi-plane or even multi-plane views, including two and three-dimensional views.

4D image information can be used with the navigation system 10 as well. For example, the user 67 can use the physiologic signal 2C, which can include Heart Rate (EKG), Breath Rate (Breath Gating) and combine this data with image data 2 b acquired during the phases of the physiologic signal to represent the anatomy at various stages of the physiologic cycle. For example, the brain pulses (and therefore moves) with each heartbeat. Images can be acquired to create a 4D map of the brain, onto which the atlas data 2 a and representations of the instrument can be projected. This 4D data set can be matched and co-registered with the physiologic signal (EKG) to represent a compensated image within the system. The image data registered with the 4D information can show the brain (or anatomy of interest) moving during the cardiac or breath cycle. This movement can be displayed on the display 34 as the image data 36.

Likewise, other imaging modalities can be used to gather the 4D dataset to which pre-operative 2D and 3D data can be matched. One need not necessarily acquire multiple 2D or 3D images during the physiologic cycle of interest (breath or heart beat). Ultrasound imaging or other 4D imaging modalities can be used to create an image data that allows for a singular static pre-operative image to be matched via image-fusion techniques and/or matching algorithms that are non-linear to match the distortion of anatomy based on the movements during the physiologic cycle. The combination of a the dynamic reference frame 54 and 4D registration techniques can help compensate for anatomic distortions during movements of the anatomy associated with normal physiologic processes.

With continuing reference to FIG. 2, the navigation system 10 can further include an electromagnetic navigation or tracking system 44 that includes a localizer, such as a coil array 46 and/or second coil array 47, the coil array controller 48, a navigation probe interface 50, a device 52 (e.g. catheter, needle, or instruments, as discussed herein) and a dynamic reference frame 54. Other tracking systems can include optical tracking systems 44′, 44″ exemplary optical tracking systems include the StealthStation® Treon® and the StealthStation® Tria® both sold by Medtronic Navigation, Inc. The dynamic reference frame 54 can include a dynamic reference frame holder 80 and a removable tracking device 54 a. Alternatively, the dynamic reference frame 54 can include a tracking device 54 a that is formed integrally with the dynamic reference frame holder 80.

The tracking device 54 a or any appropriate tracking device as discussed herein, can include both a sensor, a transmitter, or combinations thereof. Further, the tracking devices can be wired or wireless to provide a signal or emitter or receive a signal from a system. Nevertheless, the tracking device can include an electromagnetic coil to sense a field produced by the localizing array 46 or 47 or reflectors that can reflect a signal to be received by the optical localizer 44′, 44″. Nevertheless, one will understand that the tracking device can receive a signal, transmit a signal, or combinations thereof to provide information to the navigation system 10 to determine a location of the tracking device 54 a, 58. The navigation system can then determine a position of the instrument or tracking device to allow for navigation relative to the patient and patient space.

The coil arrays 46, 47 may also be supplemented or replaced with a mobile localizer. The mobile localizer may be one such as that described in U.S. patent application Ser. No. 10/941,782, filed Sep. 15, 2004, and entitled “METHOD AND APPARATUS FOR SURGICAL NAVIGATION”, herein incorporated by reference. As is understood the localizer array can transmit signals that are received by the tracking device 54 a, 58. The tracking device 58 can then transmit or receive signals based upon the transmitted or received signals from or to the array.

Other tracking systems include acoustic, radiation, radar, infrared, etc. The optical localizer can transmit and receive, or combinations thereof. An optical tracking device can be interconnected with the instrument 52, or other portions such as the dynamic reference frame 54. As is generally known the optical tracking device 58 a can reflect, transmit or receive an optical signal to the optical localizer 44′ that can be used in the navigation system 10 to navigate or track various elements. Therefore, one skilled in the art will understand, that the tracking devices 54 a, 58, and 59 can be any appropriate tracking device to work with any one or multiple tracking systems.

Further included in the navigation system 10 may be an isolator circuit or assembly. The isolator circuit or assembly may be included in a transmission line to interrupt a line carrying a signal or a voltage to the navigation probe interface 50. Alternatively, the isolator circuit included in the isolator box may be included in the navigation probe interface 50, the device 52, the dynamic reference frame 54, the transmission lines coupling the devices, or any other appropriate location. The isolator assembly is operable to isolate any of the instruments or patient coincidence instruments or portions that are in contact with the patient should an undesirable electrical surge or voltage take place.

It should further be noted that the entire tracking system 44 or parts of the tracking system 44 may be incorporated into the imaging device 12, including the work station 31, radiation sensors 24 and optimization processor 39. Incorporating the tracking system 44 may provide an integrated imaging and tracking system. This can be particularly useful in creating a fiducial-less system. Any combination of these components may also be incorporated into the imaging system 12, which again can include a fluoroscopic C-arm imaging device or any other appropriate imaging device.

The coil array 46 can include a plurality of coils that are each operable to generate distinct electromagnetic fields into the navigation region of the patient 14, which is sometimes referred to as patient space. Representative electromagnetic systems are set forth in U.S. Pat. No. 5,913,820, entitled “Position Location System,” issued Jun. 22, 1999 and U.S. Pat. No. 5,592,939, entitled “Method and System for Navigating a Catheter Probe,” issued Jan. 14, 1997, each of which are hereby incorporated by reference.

The coil array 46 is controlled or driven by the coil array controller 48. The coil array controller 48 drives each coil in the coil array 46 in a time division multiplex or a frequency division multiplex manner. In this regard, each coil may be driven separately at a distinct time or all of the coils may be driven simultaneously with each being driven by a different frequency.

Upon driving the coils in the coil array 46 with the coil array controller 48, electromagnetic fields are generated within the patient 14 in the area where the medical procedure is being performed, which is again sometimes referred to as patient space. The electromagnetic fields generated in the patient space induce currents in the tracking device 54 a, 58 positioned on or in the device 52. These induced signals from the tracking device 58 are delivered to the navigation probe interface 50 and subsequently forwarded to the coil array controller 48. The navigation probe interface 50 can also include amplifiers, filters and buffers to directly interface with the tracking device 58 in the device 52. Alternatively, the tracking device 58, or any other appropriate portion, may employ a wireless communications channel, such as that disclosed in U.S. Pat. No. 6,474,341, entitled “Surgical Communication Power System,” issued Nov. 5, 2002, herein incorporated by reference, as opposed to being coupled directly to the navigation probe interface 50.

Various portions of the navigation system 10, such as the device 52, the dynamic reference frame (DRF) 54, the instrument 52, are equipped with at least one, and generally multiple, EM or other tracking devices 58, that may also be referred to as localization sensors. The EM tracking devices 58 can include one or more coils that are operable with the EM localizer array 46 or 47. An alternative tracking device may include an optical sensor, and may be used in addition to or in place of the electromagnetic sensor 58. The optical sensor may work with the optional optical array 44′. One skilled in the art will understand, however, that any appropriate tracking device can be used in the navigation system 10. An additional representative alternative localization and tracking system is set forth in U.S. Pat. No. 5,983,126, entitled “Catheter Location System and Method,” issued Nov. 9, 1999, which is hereby incorporated by reference. Alternatively, the localization system may be a hybrid system that includes components from various systems.

In brief, the EM tracking device 58 on the device 52 can be in a handle or inserter that interconnects with an attachment and may assist in placing an implant or in driving a portion. The device 52 can include a graspable or manipulable portion at a proximal end and the tracking device 58 may be fixed near the manipulable portion of the device 52 or at a distal working end, as discussed herein. The tracking device 58 can include an electromagnetic sensor to sense the electromagnetic field generated by the coil array 46 that can induce a current in the electromagnetic device 58. Alternatively, the tracking sensor 54 a, 58 can be driven (i.e., like the coil array above) and the tracking array 46, 46 a can receive a signal produced by the tracking device 54 a, 58.

The dynamic reference frame 54 may be fixed to the patient 14 adjacent to the region being navigated so that any movement of the patient 14 is detected as relative motion between the coil array 46 and the dynamic reference frame 54. The dynamic reference frame 54 can be interconnected with the patient in any appropriate manner, including those discussed herein. This relative motion is forwarded to the coil array controller 48, which updates registration correlation and maintains accurate navigation, further discussed herein. The dynamic reference frame 54 may be any appropriate tracking sensor used as the dynamic reference frame 54 in the navigation system 10. Therefore the dynamic reference frame 54 may also be optical, acoustic, etc. If the dynamic reference frame 54 is electromagnetic it can be configured as a pair of orthogonally oriented coils, each having the same center or may be configured in any other non-coaxial or co-axial coil configurations.

Briefly, the navigation system 10 operates as follows. The navigation system 10 creates a translation map between all points in the image data generated from the imaging device 12 which can include external and internal portions, and the corresponding points in the patient's anatomy in patient space. After this map is established, whenever the tracked device 52 is used the work station 31 in combination with the coil array controller 48 and the C-arm controller 28 uses the translation map to identify the corresponding point on the pre-acquired image or atlas model, which is displayed on display 34. This identification is known as navigation or localization. An icon representing the localized point or instruments is shown on the display 34 within several two-dimensional image planes, as well as on three and four dimensional images and models.

To enable navigation, the navigation system 10 must be able to detect both the position of the patient's anatomy and the position of the instrument 52 or attachment member (e.g. tracking device 58) attached to the instrument 52. Knowing the location of these two items allows the navigation system 10 to compute and display the position of the instrument 52 or any portion thereof in relation to the patient 14. The tracking system 44 is employed to track the instrument 52 and the anatomy simultaneously.

The tracking system 44, if it is using an electromagnetic tracking assembly, essentially works by positioning the coil array 46 adjacent to the patient space to generate a magnetic field, which can be low energy, and generally referred to as a navigation field. Because every point in the navigation field or patient space is associated with a unique field strength, the electromagnetic tracking system 44 can determine the position of the instrument 52 by measuring the field strength at the tracking device 58 location. The dynamic reference frame 54 is fixed to the patient 14 to identify the location of the patient in the navigation field. The electromagnetic tracking system 44 continuously recomputes the relative position of the dynamic reference frame 54 and the instrument 52 during localization and relates this spatial information to patient registration data to enable image guidance of the device 52 within and/or relative to the patient 14.

Patient registration is the process of determining how to correlate the position of the instrument 52 relative to the patient 14 to the position on the diagnostic or pre-acquired images. To register the patient 14, a physician or user 67 may use point registration by selecting and storing particular points (e.g. fiducial points 60) from the pre-acquired images and then touching the corresponding points on the patient's anatomy with the pointer probe 66. The navigation system 10 analyzes the relationship between the two sets of points that are selected and computes a match, which correlates every point in the image data with its corresponding point on the patient's anatomy or the patient space. The points that are selected to perform registration are the fiducial markers or landmarks 60, such as anatomical landmarks. Again, the landmarks or fiducial points are identifiable on the images and identifiable and accessible on the patient 14. The landmarks 60 can be artificial landmarks 60 that are positioned on the patient 14 or anatomical landmarks that can be easily identified in the image data. The artificial landmarks, such as the fiducial markers 60, can also form part of the dynamic reference frame 54, such as those disclosed in U.S. Pat. No. 6,381,485, entitled “Registration of Human Anatomy Integrated for Electromagnetic Localization,” issued Apr. 30, 2002, herein incorporated by reference.

The system 10 may also perform registration using anatomic surface information or path information as is known in the art (and may be referred to as auto-registration). The system 10 may also perform 2D to 3D registration by utilizing the acquired 2D images to register 3D volume images by use of contour algorithms, point algorithms or density comparison algorithms, as is known in the art. An exemplary 2D to 3D registration procedure is set forth in U.S. Ser. No. 10/644,680, entitled “Method and Apparatus for Performing 2D to 3D Registration” filed on Aug. 20, 2003, hereby incorporated by reference.

Also as discussed herein, a substantially fiducial-less registration system can be provided, particularly if the imaging device 12 and the tracking system 44 are substantially integrated. Therefore, the tracking system 44 would generally know the position of the imaging device 12 relative to the patient 14 and fiducials may not be required to create registration. Nevertheless, it will be understood that any appropriate type of registration system can be provided for the navigation system 10.

In order to maintain registration accuracy, the navigation system 10 continuously tracks the position of the patient 14 during registration and navigation. This is because the patient 14, dynamic reference frame 54, and transmitter coil array 46 may all move during the procedure, even when this movement is not desired. Alternatively the patient 14 may be held immobile once the registration has occurred, such as with a head frame. Therefore, if the navigation system 10 did not track the position of the patient 14 or area of the anatomy, any patient movement after image acquisition would result in inaccurate navigation within that image. The dynamic reference frame 54 allows the electromagnetic tracking system 44 to register and track the anatomy. Because the dynamic reference frame 54 is rigidly fixed to the patient 14, any movement of the anatomy or the coil array 46 is detected as the relative motion between the coil array 46 and the dynamic reference frame 54. This relative motion is communicated to the coil array controller 48, via the navigation probe interface 50, which updates the registration correlation to thereby maintain accurate navigation.

The navigation system 10 can be used according to any appropriate method or system. For example, pre-acquired images, atlas or 3D models may be registered relative to the patient and patient space, as discussed further herein. Generally, the navigation system allows the images on the display 34 to be registered and accurately display the real time location of the various instruments and other appropriate items, such as the trackable pointer. In addition, the pointer may be used to register the patient space to the pre-acquired images or the atlas or 3D models. In addition, the dynamic reference frame 54 may be used to ensure that any planned or unplanned movement of the patient or the receiver array 46 is determined and used to correct the image on the display 36.

With additional reference to FIG. 2, the dynamic reference frame 54 can be affixed to any appropriate portion of the patient 14, and can be used to register the patient to the image data, as discussed above. For example, when a procedure is being performed relative to a cranium 17, the dynamic reference frame 54 can be interconnected with the cranium 17. The dynamic reference frame 54 can be interconnected with the cranium 17 in any appropriate manner, such as those discussed herein according to various embodiments.

To obtain a maximum reference it can be selected to fix the dynamic reference frame 54 in each of at least 6 degrees of freedom. Thus, the dynamic reference frame 54 can be fixed relative to axial motion X, translational motion Y, rotational motion Z, yaw, pitch, and roll relative to the portion of the patient 14 to which it is attached. Any appropriate coordinate system can be used to describe the various degrees of freedom. Fixing the dynamic reference frame relative to the patient 14 in this manner can assist in maintaining maximum accuracy of the navigation system 10.

In addition the dynamic reference frame 54 can be affixed to the patient in such a manner that the tracking sensor portion thereof is immovable relative to the area of interest, such as the cranium 17. A head band may form a part of the dynamic reference from 54. Further, a stereotactic frame, as generally known in the art, can be attached to the head band. Such systems for tracking and performing procedures are disclosed in U.S. patent application Ser. No. 10/651,267, filed on Aug. 28, 2003, and incorporated herein by reference.

The instrument 52 can be a DBS probe, a MER device, a catheter, etc. and each can include at least one of the tracking devices, such as the tracking device 58. The tracking device 58 can be any appropriate tracking device and can be formed in any appropriate manner such as the catheters described in pending U.S. patent application Ser. No. 11/241,837, filed on Sep. 30, 2005, incorporated herein by reference.

The catheter 52 can include the tracking device 58 at any appropriate position, such as near a distal end of the catheter 52. By positioning the tracking device 58 near the distal end of the catheter 52 knowing or determining a precise location of the distal end can be efficient. Determining a position of the distal end of the catheter 52 can be used to achieve various results, such as determining a precise position of the distal end of the catheter 52, a precise movement of the distal end of the catheter 52. It will be understood that knowing a position and moving the catheter 52 in a precise manner can be useful for various purposes, including those discussed further herein. Likewise, the catheter 52 can be directable according to various mechanisms and such as directing or pulling wires, directing or pulling signals, or any appropriate mechanism generally known in the art.

The catheter 52 can be used for various mechanisms and methods, such as delivering a material to a selected portion of the patient 14, such as within the cranium 17. The material can be any appropriate material such as a bioactive material, a pharmacological material, a contrast agent. Instead of a material, a therapy such as electrical stimulation can be used with a deep brain stimulation probe (DBS). The DBS can be used to apply a voltage, a pulse width, etc. to a selected portion of the brain.

As mentioned briefly above, the display 34 can display any appropriate type of image data 36. For example, the image data 36 can include patient specific image data that can be acquired at any appropriate time. The image data can include magnetic resonance imaging data (MRI) that can provide structural anatomical image data of the patient 14. The image data can be displayed on the display 34 for use during a procedure by the user 67. The display on the display 34 can also include various atlas image data. Atlas image data can include two-dimensional image data sets, three-dimensional image data sets, and even four-dimensional image data sets that show the change of various anatomical structures over time.

With reference to FIG. 3, a three-dimensional atlas data set 100 is illustrated for a neurological region. The neurological region illustrated in FIG. 3 can be any appropriate neurological region, such as a sub-thalamic nucleus, a cerebrum, or the like. In addition, the three-dimensional atlas 100 can be used to identify various regions of the anatomy of the patient 14 on the display 34. For example, the atlas image 100 can be registered to the image data 36 in any appropriate manner. For example, the atlas can be registered to the image data using generally known algorithms, registration or fiducial markers, and the like. Nevertheless, the 3-D atlas 100 can be used to identify or assist in identifying various landmarks within the image data 36 of the patient 14. Certain algorithms can include shape matching, space matching, or structure matching. Shape fitting algorithms can include least square fitting to match one image to another.

With reference to FIG. 4, a 2-D atlas image data 102 can be overlaid on the image data 36 of the patient 14. The display 34 can include various regions that show the image data 36 of the patient 14 from a plurality or any appropriate perspectives. In addition, the display device 34 can display a position of the instrument 52 with an icon 52 i. The icon 52 i can illustrate a position of the instrument 52 relative to a selected portion of the anatomy, such as identified by the atlas 102 or any other appropriate procedure. The atlas 102 can also be registered to the image data 36 of the patient 14 according to various known techniques, including various automatic or manual registration techniques. The registration of the atlas data 102 to the image data 36 can assist in identifying various anatomical and functional landmarks or portions of the anatomy of the patient 14.

With reference to FIG. 5, the display 34 can be used to display various types of image data, including the image data 36 of the patient 14, and atlas image data relative thereto. The appropriate type of image data displayed on the display 34 can then be used to plan a selected procedure. The planning can occur substantially pre-operatively or intra-operatively. Nevertheless, various targets 104, 106 can be displayed on the display 34 as can various trajectories 108, 110. The targets 104, 106 and the trajectories 108, 110 can be displayed on the display 34 for selection by the user 67. It will be understood that the plan can be prepared at any appropriate time to assist in performing the procedure with the navigation system 10. Also, the plan can be created manually, automatically, or combinations thereof. The plan, including a target and trajectory, can then be selected manually, automatically, or combinations thereof.

The planning procedure can use the atlas data, and functional data, discussed further herein, to assist in determining the appropriate location of the targets 104, 106. In addition, the anatomical and functional features identified in the image data 36 can be used to assist in determining the appropriate trajectory 108, 110. Various aiming devices can also be tracked in addition to tracking the instrument 52, as discussed further herein. The identification of appropriate trajectories 108, 110 or the selection of one of many trajectories, such as the selected trajectories 108, 110 can be used to assist in positioning an appropriate aiming device or the instrument 52 during a procedure.

The planning information displayed on the display 34 can also be used post-operatively to determine whether the device, such as a deep brain stimulation probe, was implanted or positioned at an appropriate location, such as a planned location 104, 106. The planning information displayed on the display 34 can be compared to post-operative image data, such as a post-operative MRI of the patient 14, to assist in determining the success or the final positioning of the selected implant. In addition, the post-operative information can be used with the optimization/programming system for the device in block 5 to assist in ensuring that an appropriate lead, therapy, or the like is provided to the selected or target location. Therefore, the planning information on the display 34 can be used to assist in ensuring that an appropriate therapy is provided to the patient, as discussed further herein.

With reference to FIG. 6, various types of anatomical or physiological information can be collected using any appropriate system and can be provided as the data 2. For example, a micro-electrode recorder (MER) can be moved through the anatomy of the patient 14. The image data 36 can be displayed on the display 34 and a position of the MER, which can be the instrument 52, can be displayed as the MER icon 120. The MER icon 120 can be displayed or superimposed on the image data 36 and also on the atlas data 102. Although the atlas data 102 can assist in determining a position of a selected location in the image data 36, the MER can be used to assist in further refining a location within the anatomy of the patient 14. Additional icons, such as bread crumb icons 122 can be displayed superimposed on the image data 36, the atlas data 102, etc. to illustrate various changes or sensed anatomical locations based upon the information recorded by the MER. The bread crumbs 122 can assist in determining a selected region, such as a functional or anatomical region, within the image data 36. A generally known recording for a selected region of the anatomy can be recorded with the MER 120 to verify the identity of an anatomical or functional portion and a location of the MER 120 can be determined via the navigation system 10. The determined location of a selected region, such as the thalamus, can be detected with the MER and can be displayed on the display 34 with one of the bread crumbs 122. The atlas location from the atlas data 102 can then be refined when being superimposed on the image data 36 of the patient 14. Also, refinement of the atlas data 102 can also be used to refine the location of other atlas or mapped locations that are illustrated with the atlas data 102.

The data used to refine the atlas data 102 or the data 2 can also be used during an operative procedure. The anatomy and neurophysiology that is depicted by the atlas data 102 and the plan created may show the probe as navigated in one location, but the intra-operative functional data may confirm it to be in another location (due to clinical shifting, etc.). To determine the next steps, or help refine a trajectory, path, or treatment should be chosen for the therapy, the atlas data 102 can be manipulated to match the intra-operative functional and observed data

It will be understood that any appropriate recording or sensing device can also be used in addition or alternatively to the MER. Other appropriate or selected sensing probes, such as an optical coherence sensor, or the like can be used to provide an appropriate anatomical or functional landmark or structure information. The atlas 102 can be enhanced or further augmented based upon the probe information to assist in determining an appropriate transformation or customization of the atlas relative to the image data 36. It will be further understood that the atlas data can be the 3D atlas data 100 or any other appropriate atlas data and need not necessarily be the 3D atlas data.

As discussed above, the atlas data, which can include the 3D data 100 or 2D data 102, can be provided. The 2D and 3D data can be displayed for viewing on the display device 34. Further, the atlas data information can be registered with the patient image information. The registration can include custom patient alignment. For example, the anterior commissure and the posterior commissure can be determined with Talairach scaling. Also, basal ganglia and local non-linear alignment or global non-linear alignment can be determined. The data can be used for digital mapping of the selected portion of the anatomy, such as the brain. Further, automatic fit or cell types can be determined. That is, cell types in the image data can be determined and displayed on the display 34 for use by the user 67. In addition, the MER can be used for automated fitting, such as by determining or assisting the determination of different cell types or anatomical or functional regions and fitting the atlas 100, 102 to the image data 36. In addition, back projection of physiology or back projection of therapeutic contacts can be used in physical atlases.

The atlas data allows for the statistical or general mapping or indication of various portions of the anatomy, such as portions in the brain, portions in the spinal cord, various anatomical features, or the like. Atlas data can be based upon various procedures or studies, such as well understood and studied anatomical scans. For example, the Schaltenbrand-Wharen or Talairach atlases are generally accepted and well understood atlases of the human brain. Portions that are identified within the Schaltenbrand-Wharen or Talairach atlases can be the atlas data that is used, as discussed above, and herein.

The atlas data can be used at any appropriate time. For example, the atlas data can be superimposed or registered to the image data of the patient for planning a procedure. The atlas data can also be superimposed or registered to the image data for use during a procedure, such as to assist in navigation. The additional instruments, such as the MER, can be used to verify the locations of various portions of the anatomy based upon the atlas data. The MER can be introduced into the brain to record activity within the brain to confirm locations identified with the atlas data.

The feedback loop 6 in the optimization procedure 1 can be used to enhance the atlas data. The atlas data can be stored in the memory system, or any appropriate memory system, and can be augmented based upon information from the procedure or post procedure follow-up. The detected or confirmed location of an anatomical feature or target, can be used to augment or provide a statistical range of the atlas data for use in future procedures. It will be understood, the atlas data can represent any appropriate data 2.

The atlas data can also be used post operatively. For example the atlas data can be superimposed onto image data acquired post operatively of a patient. The atlas data can be used to confirm long time positioning of various implants or instruments, such as DBS leads. Therefore, the atlas data can be used at any appropriate time relative to a procedure time.

With reference to FIG. 7, the image data 36 can be displayed on the display 34. The instrument 52 can include a deep brain stimulation probe 140. The DBS probe 140 can be the instrument 52 being tracked for determining its position in the brain. In addition, the stereotactic frame 80 can be provided according to various embodiments as an aiming device 142. According to various embodiments, including those discussed above, a tracking device can be positioned relative to the DBS probe. For example, a tracking device can include a small electromagnetic coil positioned at a tip 144 of the DBS probe 140. In addition, the stereotactic or aiming device 142 can be tracked by the tracking system 44 for navigation with the navigation system 10. Regardless, the location of the tip 144 of the DBS probe 140 can be displayed relative to the image data 36. For example, an icon can be displayed on or relative to the image data 36 for illustration of the position of the tip 144 of the DBS probe while performing the procedure in block 4.

The provision of the various atlas data 100, 102 and the image data 36 of the patient 14, including other information, such as the physiological data from block 2 c, can assist in registration and determination of various targets and an appropriate aiming of the aiming device 142. In addition, the tip 144 of the DBS probe 140 can be substantially precisely tracked due to various elements, such as the positioning of the tracking device 58 at the tip 144, the aiming device 142, or other appropriate mechanisms. Regardless, the exact location of the tip 144 can be navigated relative to a selected portion of the patient 14, such as the target 104, 106 defined during the planning procedure. This can allow for determination or correct placement of a select instrument, such as a DBS probe. It will be understood that any appropriate instrument can be positioned relative to the patient 14 and the DBS probe is merely exemplary. However, the precise positioning, in addition to determination of the appropriate target based on the data provided as discussed above, can assist in performing the appropriate procedure.

Although the procedure can be navigated, as illustrated in FIG. 7, direct visualization can occur via the imaging system 12 or any appropriate imaging system. Returning reference to FIGS. 2, 2A and 2B, the navigation system 10′ can include an alternative imaging device 12′, such as an intraoperative MRI system 12′ (FIG. 2A) or O-arm™ imaging system 12″ (FIG. 2B). A work station 31′ can be provided to control various portions, such as the alternative imaging device 12′, and the optical localization system 44″. Therefore, one skilled in the art will understand that the appropriate navigation system can be provided and the navigation systems 10, 10′ are merely exemplary. Further, direct visualization can be used to assist in the performing of the selected procedure. Therefore, navigation, with or without images, is merely exemplary and can be used to assist the user 67 in performing a selected procedure.

As illustrated in FIG. 7, the instrument 52 can include a the DBS 140. When positioning the DBS probe 140, it can be navigated with an electromagnetic navigation system or electromagnetic tracking system, as discussed above. In addition, the DBS probe 140 or any appropriate instrument can be positioned with no line of sight navigation. This can include positioning or navigation of the instrument simply by navigating the instrument based upon the various visualization techniques, including the image data obtained of the patient and registered to various atlas information or other appropriate systems.

Further, the image data can be used for navigation by the user 67 with the navigation system 10, 10′ in any appropriate manner. As discussed above, fiducials 60 can be provided for use to register patient space to image space. Alternatively, or in addition thereto, substantially fiducial less registration can be provided. Fiducialless registration can include providing an imaging system 12, 12′, 12″ integrated with the tracking system 44, 44′, 44″. The imaging system 12, 12′, 12″ can be integrated into the tracking system 44, 44′, 44″ so that the position of the imaging device 12, 12′, 12″ is known by the tracking system 44, 44′, 44″ so that the navigation system 10, 10′ acts as one system. In this case, fiducials may not be required to register the image data with the patient space.

In addition, substantially automatic registration can include positioning the tracking device 54 a substantially on the top or integrally with the fiducial 60 During the acquisition of the images, the fiducial 60 is present and the tracking device 54 a can be interconnected with the fiducial 60 or at substantially the same location after imaging. Therefore, the tracking system 44 can determine the position of the tracking device 54 a once the patient 14 is moved into the localization field and substantially automatic registration can occur if the fiducial points in the image data are determined.

With integration of the imaging system and the tracking system, the integrated navigation system can be provided for post-operative confirmation. That is the navigation system can be used to confirm the positioning of the instrument, such as the DBS probe 140, in the procedure. The post-operative confirmation can be substantially immediately post-operative or at a later time, but can be used to ensure the appropriate positioning of the probe 140. The position of the probe 140 can again be determined based upon the atlas information, which can be provided relative to post-operative image data or any other appropriate system.

As discussed above, any appropriate procedure can occur. For example, the positioning of a deep brain stimulation probe 140 can be performed. As is generally known in the art, the deep brain stimulation probe is then programmed or can be programmed post-operatively to apply a selected therapy, such as a voltage to the area of the anatomy relative to positioning of the probe. It will be understood, however, that any other appropriate therapy can be provided, such as a pharmaceutical delivery, a gene or cell therapy, a radiation therapy, or the like. The exemplary discussion of a deep brain stimulation programming is provided for illustration. Further, as discussed above, the appropriate positioning of the deep brain stimulation probe can be provided based upon atlas data, physiological, or patient specific data (e.g., image data of the patient, physiological data of the patient, MER data of the patient, optical coherence tomography data of the patient).

With reference to FIG. 8, the various physiological data can be provided with any appropriate system, such as the MER, optical coherence tomography, or the like. Further, these various instruments can be tracked with the tracking system 44, 44′, 44″ as discussed above. Therefore, the exact position of various portions of the anatomy, such as portions of the brain, can be determined and sensed with the various sensing probes or recorders. This can allow the image data to be substantially real time mapped for use in the procedure in block 4. For example, the atlas data 102, 104 can be substantially real time updated, morphed or translated for use during the procedure with sensing probes, such as the MER. This can assist in determining an exact location of various anatomical structures or functional structures for assisting in determining a selected position to implant the DBS probe 140, or any appropriate system or implant. The determination of physiological data can assist during a procedure to ensure an appropriate identification of a selected anatomical or functional structure and can assist in updating, in substantially real time, a selected physical or functional map of the anatomy. Tracking the instrument while determining the physiological feature assists in its appropriate determination and location.

The placement and appropriate therapy can be determined using the various data, such as the patient specific data, including physiological image data, and atlas data. For example, the work station 31, illustrated according to various embodiments in FIG. 8, can include the display 34 that displays the image data 36 and the atlas data 102. Further, displayed relative to the image data 36 and the atlas data 102 can be an icon 150 illustrating a position of the DBS probe 140 in the anatomy. The illustration of the probe as the icon 150 can also be provided for substantially post-operative programming of the implant.

It will be understood that the position of the probe in the anatomy can be determined in any appropriate manner, such as based upon the navigation during the procedure, based on post-operative imaging of the patient, based on post-operative tracking of the tracking sensor, or any appropriate manner. Nevertheless, the determination of the position of the probe and its illustration as the icon 150 relative to the image data 136 can be used to assist in programming the DBS probe or lead in an appropriate manner. Further, the various data collected during the procedure can also be illustrated relative to the image data 36 and the atlas data 102, such as the neuro-physiological data that can be collected with the various instruments, such as the MER or optical coherence tomography. This information, including the physiological data, functional data, and location data, can also be used for later programming and operation of the DBS lead. For example, the location of the lead relative to a functionally identified region of the anatomy can be used to assist in programming the amount of therapy to be delivered from the lead.

With continuing reference to FIG. 8, the workstation 31 can be used to program an implant, such as the DBS probe or lead. It will be understood that the workstation 31 can be the workstation 31 used during the navigation or can be any appropriate workstation. The workstation 31 can allow programming of the DBS probe in a generally known manner. Information from the procedure during which the implantation of the instrument occurred can be used. Further, the data from block 2 of the optimization procedure can be used to assist in the programming of the implants. Programming the implants can include determining a voltage level, determining a pulse width, frequency, power level, frequency, or other features. The information from the procedure, such as the exact location within the brain, the determined anatomical or functional structures near the position of the implant, or the like can be used in programming the implants. Therefore, the information obtained during a procedure can be used both in a general statistical sense, for use with other patients, and for use in post-operative work on a specific patient.

With reference to FIGS. 9A and 9B, the display of the image data 36 including the icon 150 of the DBS probe can be illustrated relative to a first therapy icon 152 a. It will be understood that the representation of the atlas 102 can also be included if selected, and its absence from FIGS. 9A and 9B is merely for clarity of the illustration. Nevertheless, when the probe is being programmed, which can occur substantially intraoperatively or post-operatively, a selection of a voltage, a pulse width, or other appropriate programmable features, including a selection of appropriate leads can be used.

The therapy icon 152 a can illustrate an assumed or predicted treatment affected area. The therapy icon 152 a can illustrate a size, density amount, etc. of the therapy. The therapy icons, according to various embodiments, generally illustrate a localized affect on the anatomy. The localized affect or treatment area can be based upon the data 2. Generalized affects on the patient can be determined after the therapy is applied, such as reduction of Parkinson's disease symptoms.

The first or initial therapy icon 152 a can illustrate an affected area based upon a selected or programmed therapy for viewing by a user, which can include the surgeon 67. It will be understood that the initial therapy icon 152 a can illustrate a size, a geometry, a density, and the like of the therapy that is selected or programmed. It will be understood that the initial icon 152 a can merely be a virtual representation of the predicted effect of a selected therapy. In addition, it will be understood that the image data 36 and the various icons can be two-dimensional, three-dimensional, four-dimensional or the like. Therefore, the representation of the two-dimensional image data 36 and the two-dimensional initial therapy icon 152 a is merely exemplary. Nevertheless, the initial therapy icon 152 a can illustrate the possible or selected affect area of a selected therapy on the anatomy.

Turning to FIG. 9B, the image data 36 can be illustrated with the probe icon 150 and a secondary therapy icon 152 b. The secondary therapy icon 152 b can illustrate a predicted affect of a second selected therapy, such as a higher pulse width. The higher pulse width may affect a higher density or higher number of cells within a selected geometrical region. Therefore, the second therapy icon 152 b can illustrate or graphically illustrate the higher density of the cells being affected. Therefore, the initial therapy icon 152 a can be substantially transparent while the second therapy icon 152 b may be substantially opaque.

The icons 152 a, 152 b can illustrate representation of a possible or selected therapy on the patient prior to instigating a therapy on the patient. This can allow for substantially a graphical programming of the implant to make the programming of the implant more efficient and require fewer attempts to obtain an optimal therapy. The predicted affect using the therapy icons 152 a, 152 b can also be used during the procedure to ensure that an instrument is positioned in an appropriate location for the selected or predicted therapy.

The therapy icons 152 a, 152 b, according to various embodiments, can be used to predict an area that will be affected by therapy, ensure that an instrument is implanted in the appropriate location for providing a therapy, or a procedure to position an instrument to provide a therapy. Therefore, it will be understood, that the therapy icons are not only provided for a single part of the procedure, but can be provided for multiple parts of the procedure. The therapy icons can be used to plan a procedure, perform a procedure, and post operatively to provide a treatment to the patient. In any of these situations, the icons can be displayed on the display device for use by the user 67 to optimize the therapy for the patient 14.

In addition to a therapy density, a therapy field of shape, depth, or other geometry can also be selected and visualized. With reference to FIGS. 10A and 10B, and initially to 10A, the image data 36 can be illustrated relative to a second initial therapy icon 160. The second initial therapy icon can include two lobes or portions 160 a and 160 b. The two portions 160 a, 160 b of the second initial therapy icon 160 are merely exemplary of any appropriate or possible geometrical shape. Nevertheless, the second initial therapy icon 160 can illustrate that a proposed or selected therapy will affect a region generally having a longitudinal axis A. The longitudinal axis A may be provided relative to the image data 36 for viewing by the user 67. The longitudinal axis A and the icon portions 160 a, 160 b can be used by the user to determine whether a selected geometrical area is appropriate for the provided therapy. Further, the icon portions 160 a, 160 b can also include differing opacities to represent different densities of the therapy.

With reference to FIG. 10B, a secondary therapy icon 170 is illustrated. The second secondary therapy icon 170 can include a first portion 170 a and a second portion 170 b. The two portions 170 a and 170 b can define a longitudinal axis B relative to the image data 36. The longitudinal axis B can be different than the longitudinal axis A, such as including a different angle relative to the image data 36. Although the icon portions 170 a, 170 b can include different opacities or similar opacities, the icons can represent a different geometrical shape relative to the image data 36 of the patient 14. The different geometrical shapes can illustrate a different geometrical application of the therapy relative to the patient, illustrated in the image data 36.

The therapy icons can be illustrated in any appropriate orientation relative to the image data or atlas data. The illustration of the therapy icons, whether to illustrate a different size, different therapy type, different therapy amounts, or the like can be illustrated for procedure planning, procedure performance, or post operative treatment provisions. Moreover, the therapy icons can be illustrated to assist a user in determining an appropriate or optimal therapy provision. For example, the user can view on the display device the predicted therapy and determine the effect of the treatment on the patient. Therefore, the therapy icons can be used to determine whether a predicted therapy is having a predicted affect on the patient 14.

It will be understood that the various icons 152, 160 and 170 can represent two-dimensional, three-dimensional, four-dimensional, or any appropriate geometrical shapes. The icons provide a graphical representation of a proposed or selected therapy on the image data 36 of the patient 14. The icons 152, 160, 170 can illustrate a depth, geometry, affected area, amount of affected cells, charge over time, etc. of the selected therapy. The graphical representation can be used by the user 67 to assist in determining the appropriateness of the selected therapy. In addition, the graphical representation can be used to ensure that the therapy is being provided to an appropriate location within the anatomy. Again, the provision of the atlases 102, 104 can assist in this. Also, the various data that is determined intraoperatively or post-operatively, such as the physiological data, can be used to ensure or augment or customize the atlases relative to the particular patient 14. Therefore, the image data 36 during the programming phase in block 5 can also be illustrated or displayed relative to the atlas data to assist in determining whether the therapy is being applied to a selected or appropriate location.

Thus, one skilled in the art will understand that the optimization system 1 can be used to assist in all of a preoperative planning, an intraoperative procedure, and a post-operative follow up or programming. The programming can be of any appropriate system, such as the deep brain stimulator, a therapy application, a pacer, or any appropriate implant system. In addition, the optimization system 1 can include any appropriate or be used with any appropriate navigational or imaging system to assist in obtaining the appropriate image data. Also the various probes or sensors, such as the MER, can be used to assist in customizing an atlas relative to the particular patient to assist in locating or determining appropriate anatomical or functional regions.

The optimization system 1, diagrammatically illustrated in FIG. 1, and taught and described above, can be provided with a substantially graphical user interface (GUI) to assist in performing a procedure. As illustrated in FIG. 11, a system with a selected GUI can be provided for use with the system 1. The various illustrations include exemplary screen shots from the work station 31. The image data 36 can be provided on the display 34 for manipulation by a user employing the user input 38. As illustrated above, various types of data can be provided that include those graphically illustrated in block 202 in FIG. 11. It will be understood that additional information can also be provided, including an optical coherence data, illustrated in FIG. 12 below. The optical coherence data 220 can be displayed relative to a graphical or diagrammatic representation of the brain 221 and an instrument obtaining the optical coherence data.

The data, with reference to FIGS. 11 and 12, can include image data 36 and an initial atlas fitting, such as the two-dimensional atlas 102. In addition, various types of physiological data can be provided, such as with an MER that can create or report an electrical signal 204. The electrical signal 204 can be illustrated on the display 34 and can also be illustrated relative to a diagram or position of the MER, in the anatomy of the patient 14 relative to the image data 36. A substantially pre-registered or custom display of the atlas data can be provided or illustrated at block 206. The various data, such as data recorded by the MER can be illustrated as various icons 208. The various icons 208 or the data recorded by the MER can be used to create a substantially custom or real time registration or morph of the atlas data 102 to the image data 36 of the patient. This can allow substantially real-time registration of the atlas 102 to the patient data 36. This can also allow for a substantially precise locating or positioning of various portions, such as a deep brain stimulation probe relative to the patient using the image data 36.

A graphical planning can be provided based upon the various data collected either intraoperatively or preoperatively. The planning, graphically illustrated at 210, can occur at any appropriate time, as discussed above. Further, the planning or planned procedure can be changed substantially intraoperatively based upon obtained information, including the substantially real time registration or morphing of the atlas data 102 to the patient data or image data 36.

The various types of data can then be used to assist in programming or selecting a particular therapy. The optimization programming of block 5 is graphically illustrated in block 212. As discussed above, the various graphical displays can illustrate icons that illustrate how a therapy is predicted to affect various portions of the anatomy and can be used to substantially, precisely and efficiently program a particular therapy, such as a deep brain stimulation, cell therapy, gene therapy, or the like. Nevertheless, the icons can assist in determining or illustrating how a therapy will likely affect various portions of the anatomy and can be used to assist in more precisely or efficiently programming the system. Also as discussed above, the illustration of how a therapy might affect the anatomy can be used in planning the procedure, such as selecting an appropriate target, trajectory, or the like.

Moreover, the target can be reached based upon a linear or non-linear path. Optimization of a therapy can include determining the appropriate path and trajectory to reach a selected location in the anatomy. Again, the data 2 can assist in identifying regions of the anatomy to provide a treatment to and assist in identifying the trajectory or path to reach the target for therapy.

One skilled in the art will understand that the predicted affected or therapy icons illustrated an empirical physiological effect. The actual effect on the patient's symptoms can differ from patient to patient. Therefore, the icons can be used in future models and also to determine an amount or location of treatment provided to a selected patient. As the therapy for the selected patient is refined, reference can be made to the previous therapy areas or type illustrated with the icons.

The description of the present teachings is merely exemplary in nature and, thus, variations that do not depart from the gist of the present teachings are intended to be within the scope of the present teachings. Such variations are not to be regarded as a departure from the spirit and scope of the present teachings. 

What is claimed is:
 1. A system for performing a procedure on an anatomy of a patient, comprising: a first memory system storing database data; an instrument operable to obtain functional patient specific data; and a processor operable to access the first memory system and operable to execute instructions to perform an initial registration of the patient specific image data and the database data and perform a second registration of the patient specific image data and the database data based at least in part on the obtained functional patient specific data.
 2. The system of claim 1, wherein the database data includes atlas data, average functional data, the functional patient specific data previously acquired, or combinations thereof.
 3. The system of claim 1, further comprising: a display device operable to display the patient specific image data after performing the second registration; and an icon displayed on the display device to identify a target in the displayed image data.
 4. The system of claim 3, wherein the target icon is created at a location defined via a user input, an automatic determination of the target by the processor, or combinations thereof.
 5. The system of claim 3, further comprising: a second icon operable to illustrate a predicted localized physiological affect of a therapy superimposed on the patient specific image data.
 6. The system of claim 5, wherein the second icon displays a localized physiological affect of a voltage, an affect of a pulse width, an affect of a chemical volume delivered, an affect of a biological treatment delivered, an affect of a radiation treatment delivered, an affect of therapy over time, or combinations thereof.
 7. The system of claim 6, further comprising: a deep brain stimulation lead operable to be implanted in the anatomy of the patient; and a treatment device operable to be programmed to provide a therapy through the deep brain stimulation lead implanted in the anatomy based at least in part on the localized physiological affect displayed on the display device.
 8. The system of claim 7, further comprising: a tracking system including a localizer and a tracking device, wherein the tracking device is associated with at least one of the deep brain stimulation lead or the instrument.
 9. The system of claim 1, further comprising: an imaging system operable to obtain the patient specific image data; and a tracking system including a localizer and a tracking device; wherein a position of the tracking device is operable to be determined and indicated relative to the patient specific image data.
 10. The system of claim 1, wherein the functional patient specific data includes at least one of a microelectrode recording data, pressure data, gating data, or combinations thereof.
 11. The system of claim 1, wherein the instruction includes at least one of a microelectrode recorder, a catheter, a scope, a pressure monitor, or combinations thereof.
 12. A system for performing a procedure on an anatomy of a patient, comprising: an electronic processor to execute instructions to perform an initial registration of a patient specific image data and a database data at a first time; and an instrument having a sensing portion to obtain functional patient specific data after the first time; wherein the electronic processor executes further instructions to perform a second registration of the patient specific image data and the database data at a second time based at least in part on the obtained functional patient specific data with the instrument.
 13. The system of claim 12, further comprising: a first memory system storing the database data; wherein the electronic processor is in communication with the first memory system.
 14. The system of claim 13, further comprising: a display device in communication with the electronic processor and configured to display the patient specific image data after at least the second registration.
 15. The system of claim 14, further comprising: a tracking system having at least a tracking device associated with the instrument operable with a localizer to track a location of the instrument.
 16. The system of claim 15, wherein the tracking system includes at least one of an electromagnetic localizer or an optical localizer.
 17. The system of claim 15, wherein the electronic processor is configured to execute instructions to illustrate a tracked location of the instrument superimposed on the patient specific image data illustrated with the display device.
 18. The system of claim 13, further comprising: an imaging system operable to obtain the patient specific image data for registration to the database date.
 19. A system for performing a procedure on an anatomy of a patient, comprising: an instrument having a sensing portion to obtain functional patient specific data; a tracking system having at least a tracking device associated with the instrument; an electronic processor to execute instructions to perform a refined registration of a patient specific image data and a database data based upon at least one tracked location of the instrument; and a display device configured to display patient specific image data and at least one breadcrumb icon illustrating at least a location of the functional patient specific data sensed with the sensing portion.
 20. The system of claim 19, wherein the electronic processor is further configured to execute instructions to perform an initial registration of the patient specific image data and the database data prior to the refined registration.
 21. The system of claim 20, further comprising: a deep brain stimulation lead configured to be placed at a patient target location represented in the patient specific image data.
 22. The system of claim 21, further comprising: an imaging system to obtain the patient specific image data.
 23. The system of claim 19, wherein the electronic processor is further configured to execute instructions to determine a patient target based on the performed refined registration. 